The Challenge

If viewed as a medical procedure, the patient interview is arguably, the tool most routinely employed by health care clinicians. And yet, during a typical medical career, while a clinician may conduct as many as 150,000 patient interviews, communication training for clinicians and other health care professionals has historically received far less attention throughout the training process than have other clinical tasks.

This is so even as evidence continues to mount that a structured approach to communication measurably improves health care delivery.

  • There is a clear correlation between doctor communication skills and the patientâs willingness (or ability) to comply with a medical regimen.
  • A physicianâs ability to explain, listen and empathize can have a profound effect on patient satisfaction and confidence.
  • Improving doctor-patient communication has been shown to be an important step toward better results in the areas of preventative medicine and long-term management of chronic illness.
  • Improved communication between doctor and patient is an important factor in reducing the likelihood of malpractice suits.

The Canadian Cancer Society has conducted two needs assessments, first in 1989 and then in 2003. Analysis of these studies revealed that, while patients expressed admiration for their health care providers, they also identified what was perceived to be a major disconnect in communication, not only between the provider and patient, but also between providers themselves. Patients frequently expressed feeling rushed, part of a healthcare assembly line, and often left their clinicianâs office without receiving clear answers to their queries.

As a consequence to this expanding body of evidence, as well as a growing trend toward reviewing patient satisfaction and medical errors as part of hospital/university accreditation, many health care facilities are recognizing the ongoing need for health care communication and most medical schools are expanding their communication training throughout the undergraduate, postgraduate and continuing education levels. Doctor-patient communication, once considered to be mere ãbedsideä manner, is now considered an important practical skill; however, many health care professionals practicing today have had little or no formal training in or reinforcement of effective communication techniques.

The Solution

In the mid to late 1980s, a number of efforts aimed at improving communication between health care professionals and clients were initiated. One important program was the Bayer Institute for Health Care Communication, which was established 1987 in the United States (US). Established as a non-profit organization, the Instituteâs mission was to enhance the quality of health care by improving the communication between clinician and patient through three major activities: education, research, and advocacy.

The Institute came to Canada in 1997, and was established as a branch of the US organization, with the Canadian branch using the US programs, and providing membership within their governance structure. In 2005, following changes in the revenue sources for the Institute, a new name was adopted – Institute for Healthcare Communication (IHC).

The IHC workshops, and the materials and programs used in them, were / are based on the best available evidence of what constitutes effective clinical and education practice and offer an innovative approach to education in the communications field. Based on the overarching tenet that effective communication between clinician and patient is a necessity — not an option, all IHC programs are designed to be interactive and experiential, featuring case review videos, simulations and case studies. Since its inception in North America, IHC faculty have conducted more than 9,000 workshops for more than 120,000 clinicians and health care workers.

As in the US, the workshops in Canada proved to be extremely well received and successful, with the initial focus on medical school curriculum at all levels of training. Attention was also given to major teaching hospitals, including The University Health Network (UHN), and the Toronto East General Hospital (TEGH), as well as cancer centers across the country. The courses and workshops had received approval for accredited continuing medical education through both the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada.

The IHC Program

The IHC works with health care organizations to provide educational opportunities to make it possible for clinicians to develop the communication skills they need to be effective. All programs, designed for small groups of 10 to 25 participants, are based on current research literature, keep didactic presentations to a minimum, encourage active learning through case-based discussions, group exercises, video case review, and communication skills practice.

Arrangements can be made through the IHC-C office to bring trained Canadian faculty leaders to present the course workshop for local staff at any given institution. The IHC-C has over 200 facilitators, trained in one or more IHC workshops, and representing more than 40 academic and health care institutions across the country. Alternatively, the IHC-C can also provide ãTrain the Trainerä, or ãFacultyä courses; this model of training allows the newly trained IHC Faculty to lead and facilitate continuing education (CE) workshops on this topic for others in the health care community in their own geographical area.

Using the Four E model – engage, empathize, educate, and enlist – the basic communications module, ãClinician-Patient Communicationä, continues to be the flagship of the IHC program. The primary focus of this workshop is to learn to apply effective communication strategies in order to enhance diagnostic accuracy, improve involvement of the patient in decision making, increase likelihood of adherence to therapeutic regimens, as well as to increase patient / clinician satisfaction, and reduce likelihood of malpractice litigation. All courses are listed below, with more detailed course descriptions are provided in the Course Section.

IHC-C Programs

  • Clinician-Patient Communication
  • Difficult Clinician-Patient Relationships
  • Choices and Changes
  • Conversations at the End of Life
  • Care not Cure
  • Beyond Informed Consent
  • Treating patients with C.A.R.E.
  • Coaching for Impressive C.A.R.E.
  • Disclosing Unanticipated Outcomes and Medical Errors
  • Strangers in Crisis
  • Connected: Communicating and Computing

The Current Situation

Since the changes in financial support in 2004, the IHC faculty and programs in Canada have not had local support and therefore, IHC activity has decreased significantly since this time. To counteract this, in 2005, a group of individuals, comprised of members of The College of Family Physicians of Canada (CFPC), the Canadian Cancer Society – Ontario Division (CCS-OD), and Cancer Care Ontario (CCO), formed a partnership, whose primary goal is to revitalize the Institute for Healthcare Communication in Canada – namely, the IHC-C. The desire to have the IHC thrive in Canada once again is clearly reflected in the newly established vision of the IHC-C – ãTo optimize the healthcare experience and the quality of patient care through effective communication.ä

The three parent organizations (CCS-OD, CCO and CFPC) have formed the Canadian Operating Committee (COC), whose intention is to provide a governance structure to guide the Canadian program through its renewal period In Canada. Recent strategic planning sessions have initiated the process by engaging Canadian staff to facilitate this process; the CFPC has provided a home and will be the base of operations for the IHC-C renaissance, and the CCS-OD and CCO have generously provided financial resources to cover the start up period.

Throughout 2006, contact has been reestablished with Canadian faculty, clients and stakeholders. The IHC-C faculty members represent over 40 different health care facilities, including universities, hospitals and cancer care agencies, with representation in virtually every province across the country. A formal ãlaunchä event was held in November 2006, with the purpose of retraining, revitalizing and reenergizing existing faculty across the country. A strategic planning session set for early in 2007 will focus on the future of the IHC-C and establishing a clear plan which will allow the IHC-C to continue to grow and flourish in Canada.